J-P Shiau1,2, C-C Chin3, C-N Yeh4, J-F Chen5, S-T Lee6, J-F Fang7, C-C Liao8,9. 1. Department of General Surgery, Tzu-Chi General Hospital and Tzu-Chi University, No.289, Jianguo Rd., Xindian Dist, New Taipei City , 23142, Taiwan, ROC. gp5066@gmail.com. 2. Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. gp5066@gmail.com. 3. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. chinchihching@gmail.com. 4. Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. ycn@gmail.com. 5. Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. chenjf@adm.cgmh.org.tw. 6. Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. yun0710@adm.cgmh.org.tw. 7. Division of Trauma, Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. jimjffang@hotmail.com. 8. Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. liao2901.tw@gmail.com. 9. Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. liao2901.tw@gmail.com.
Abstract
PURPOSE: Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. METHODS: This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. RESULTS: A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters. CONCLUSIONS: This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.
PURPOSE: Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. METHODS: This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. RESULTS: A total of 826 adult traumapatients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters. CONCLUSIONS: This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.
Authors: Margaret M Griffen; Eric R Frykberg; Andrew J Kerwin; Miren A Schinco; Joseph J Tepas; Kathleen Rowe; Jennifer Abboud Journal: J Trauma Date: 2003-08